Abstract

The contribution of gender identity, neighborhood characteristics, contextual norms, and socio-political factors to the biopsychosocial health of non-heteronormative persons in low- and middle-income countries (LMICs) is understudied. Using syndemic theory, we conducted two focus groups (FGs) of 16 non-heteronormative individuals in Haiti's urban Cité Soleil neighborhood. Eight individuals participated in each FG. ATLAS.ti facilitated thematic content analysis of transcripts. Results indicate that disparity conditions in Cité Soleil (extreme poverty, gang violence, easy access of weapons by criminals, lack of law enforcement, and a 3.6% Human Immunodeficiency Virus [HIV] rate) facilitate a syndemic of substance abuse and non-partner sexual violence. These interact adversely with gender expression, transphobia, transmisogyny, cissexism, lack of confidential HIV testing, and hostilities from religious groups to increase participants' risks of coercive non-partner sexual violence by groups of inebriated men. Injuries from sexual violence, limited access to confidential HIV testing, and inaccurate HIV knowledge heighten HIV risk and anxiety. Haiti’s negative human rights record, 2.2% HIV prevalence, and cultural norms that devalue women are syndemic pathways that perpetuate or worsen disparity conditions and health risks, particularly for trans women. It is a moral, ethical, public health, and social justice mandate to address HIV prevention and mental health promotion for Haitian trans women.

摘要

性别认同、邻里特征、背景规范和社会政治因素对低收入和中等收入国家 (LMIC) 的非异性恋者的生物心理社会健康的贡献尚未得到充分研究。我们使用 Syndemic 理论，在海地的城市太阳城附近对 16 名非异性恋个体进行了两个焦点小组 (FG)。每个 FG 都有八个人参加。ATLAS.ti 促进了成绩单的主题内容分析。结果表明，太阳城的差异条件（极端贫困、帮派暴力、犯罪分子容易获得武器、缺乏执法以及 3.6% 的人类免疫缺陷病毒 [HIV] 率）促进了药物滥用和非伴侣性行为的综合性暴力。这些与性别表达、跨性别恐惧症、跨性别、顺性别、缺乏保密的 HIV 检测，以及宗教团体的敌对行动，增加了参与者遭受醉酒男子团体胁迫性非伴侣性暴力的风险。性暴力造成的伤害、获得保密 HIV 检测的机会有限以及 HIV 知识不准确会增加 HIV 风险和焦虑。海地的负面人权记录、2.2% 的艾滋病毒流行率以及贬低女性价值的文化规范是使差异状况和健康风险长期存在或恶化的综合途径，尤其是对跨性别女性而言。为海地跨性别女性解决艾滋病毒预防和心理健康促进问题是一项道德、伦理、公共卫生和社会正义任务。性暴力造成的伤害、获得保密 HIV 检测的机会有限以及 HIV 知识不准确会增加 HIV 风险和焦虑。海地的负面人权记录、2.2% 的艾滋病毒流行率以及贬低女性价值的文化规范是使差异状况和健康风险长期存在或恶化的综合途径，尤其是对跨性别女性而言。为海地跨性别女性解决艾滋病毒预防和心理健康促进问题是一项道德、伦理、公共卫生和社会正义任务。性暴力造成的伤害、获得保密 HIV 检测的机会有限以及 HIV 知识不准确会增加 HIV 风险和焦虑。海地的负面人权记录、2.2% 的艾滋病毒流行率以及贬低女性价值的文化规范是使差异状况和健康风险长期存在或恶化的综合途径，尤其是对跨性别女性而言。为海地跨性别女性解决艾滋病毒预防和心理健康促进问题是一项道德、伦理、公共卫生和社会正义任务。